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110 DERBY ST UNIT 1_2.14.23_ CLAIM GEICO Insurance Agency, LLC Underwritten By: Homesite Homesite Insurance Company Of The Midwest Tel: 1-800-566-1518 HOME INSURANCE Fax: 1-866-935-2858 6000 American Parkway Madison,WI 53783-0001 e5269002 NN RP Is W2s0sr6 NNNNNNNN 0000%5 000s Claim Number: 01-005-880332 SALEM CITY BUILDING INSPECTOR OFFICE Date Of Loss: 02/14/2023 120 WASHINGTON ST Policy Number: 39125813 SALEM, MA 01970-3545 Policyholder: Collin J Murray And Kelly Murray IIIIII�I"I��I�I'�IIII"II'�'�I"�II�IIIIIIIIIIIIII,IIII II I I�III� March 15, 2023 ATTENTION: Building Commissioner or Inspector of Buildings Fire Department or Arson Squad, Board of Health or Board of Selectmen C/O City or Town Hall _ NOTICE PURSUANT TO MASS. GEN. LAWS, CHAPTER 139, SECTION 3B Our Insured: COLLIN J MURRAY Property Address: 110 Derby St# 1 Salem, MA, 01970-5647 Policy Number: 39125813 Claim Number: 01-005-880332 Date of Loss 02/14/2023 This correspondence shall serve as notice that, pursuant to Massachusetts General Laws Chapter 139, Section 3B, a claim has been made involving loss, damage or destruction to a building or other structure which may either exceed$1,000 or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice pursuant to Massachusetts General Laws Chapter 139, Section 3B is appropriate, please direct such notice to my attention and kindly, pursuant to the information provided above, include the insured's name, address, policy number, claim number and date of loss. If you contact us via email, please use claimdocuments@afics.com and be sure to reference the claim number in the subject line of your email. Please contact me with any questions. Sincerely, Perry Casey Claim Senior Adjuster AFICS on behalf of Homesite Insurance Company of the Midwest Perry.Casey@afics.com Phone: 1-224-240-5837 1 Fax: 1-866-935-2858 Mail: 6000 American Parkway, Madison, WI 53783-0001 4 _ 5§ 2-3 AR Page 1 of 1